Care Management Specialist

1 week ago

Saginaw, United States SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITY Full time

POSITION SUMMARY:

A high number of candidates may make applications for this position, so make sure to send your CV and application through as soon as possible.

Under supervision of the Care Management Supervisor, monitors appropriate uses of Saginaw County Community Mental Health Authority (SCCMHA) resources for treatment and support of individual episodes of care, coordination of care and adequacy of supports and services to sustain outcomes. This position uses best practice that are derived from scientific evidence to bring together health care resources from across the continuum of care in the most appropriate, effective, and efficient manner to care for the client Specific duties in utilization review may be assigned within individual staff scope of practice and target population expertise. Performs responsibilities and tasks with a demeanor and attitude that promotes goodwill, builds positive relationships, communicates respect for human dignity and contributes positively to the mission and values of SCCMHA. This position will be knowledgeable about and actively support culturally competent recovery-based practices; person centered planning as a shared decision-making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid consumer in the recovery process.

ESSENTIAL DUTIES AND RESPONSIBLITIES:

1. Provides preauthorization of services based on review of assessments and the medical record for evidence of medical necessity and within the definition of the benefit. Acts on behalf of the client to assure that necessary clinical services are received and that progress is being made. If denial of service is indicated this position will review pending denial in multidisciplinary Care Conference. If denial or reduction of service is supported in conference, will ensure due process of Adequate or Advanced notice to the consumer.

2. Works closely with the Central Access and Intake unit to facilitate eligibility assessment, referral and team assignment for new consumers.

3. Reviews level of functioning assessments including CAFAS, LOCUS, SIS, ASAM and others as implemented by SCCMHA and decides on appropriate level of care placement for mental health and substance use treatment services.

4. Works in multiple electronic health record systems with the ability to ensure data integrity and accurate data interface between systems.

5. Provides concurrent review of community-based services and works as a team member with utilization management tasks related to management of the entire behavioral health benefit. These services include, but are not limited to, assessment, care planning, education, referral, advocacy, monitoring, and periodic reassessment. Brief therapy, Enhanced Services and Supports Coordination and ACT. Episodes of care may be selected for sample review or flagged for review due to under or over utilization or due to inadequate documentation in the person-centered plan and supporting assessments. Concurrent review of services includes review of assessment and plan for concurrence with Service Selection guidelines and protocols, consultation with primary care provider and/or consumer, and may include written recommendations to the provider and consumer incorporating suggestions for modifications in the plan.

6. Through concurrent review, may recommend the denial of authorization or reauthorization of service or may suggest reduction in the quantity or duration of services. If reduction or denial of service is recommended, will review the proposed reduction or denial in multidisciplinary Care Conference. If denial or reduction of service is supported in conference, will ensure due process of Adequate or Advanced notice to the consumer.

7. Prepare written justification of denial with suggestions for alternative resources when denying services through preauthorization review or concurrent utilization review documentation.

8. May issue recommendation for provider restitution of payments if documentation of eligibility is not complete or adequate to support eligibility certification in the medical record.

9. Prepares individual utilization profile analysis reports and makes recommendations for primary care providers. Profile preparation includes data analysis, record review and written analysis and recommendations.

10. Conduct provider training in Care Management Policies and procedures, service selection guidelines, eligibility assessment criteria, severity of illness/intensity of service requirements, coordination of care standards, service protocols and utilization management performance indicators. Training may also be provided to other groups including Citizens Advisory Committee, community groups and others as requested by the Director of Care Management and Quality Services. The role of through these trainings will be to reduce the incidence of denial or reduction of service decisions.

11. Participates in multidisciplinary Care Conference for the review of all adverse decisions and individual and provider profile review and related care management performance indicators.

12. Participates in process improvement committees as assigned, including preparation of summaries of findings for review by supervisory staff.

13. Is responsible for accurate and timely codification and entry of data and writing of reports, communication of decisions to providers and consumers.

14. Preserves confidentiality of information accessed in performance of assigned duties.

15. Uses supervision to resolve areas of performance concerns and to facilitate professional growth and development.

16. Adheres to the mission, vision, core values and operating principles of SCCMHA at all times.

QUALIFICATIONS:

Education: Master’s degree in a mental health related field from an accredited school required.

Experience: A minimum of five (5) years progressive experience in preferably diverse treatment settings including: psychiatric inpatient, outpatient, managed care, and case management. Consideration of experience and scope of practice will be uniquely considered for each team vacancy as the agency requires a team which enables us to manage a wide range of special needs populations (developmental disabilities, substance abuse, VA, children’s, mentally ill and medical health specifically in a hospital setting and/or medical clinic.) and determined in interviews, with depth and range given more preference.

Licenses and Certifications: Valid Michigan Driver’s license with a good driving record.

Must be able to apply and obtain a limited licensed master’s social worker (LLMSW), licensed master’s social worker (LMSW), limited licensed professional counselor (LLPC), licensed professional counselor (LPC), limited licensed marriage and family therapist (LLMFT), licensed marriage and family therapist (LMFT), limited licensed psychologist (LLP) and licensed psychologist (LP). Must have or obtain a certification in substance use treatment specialist area.

  • Care Management Specialist

    2 weeks ago

    Saginaw, United States Saginaw County Community Mental Health Authority Full time

    POSITION SUMMARY: Under supervision of the Care Management Supervisor, monitors appropriate uses of Saginaw County Community Mental Health Authority (SCCMHA) resources for treatment and support of individual episodes of care, coordination of care and adequacy of supports and services to sustain outcomes. This position uses best practice that are derived...

  • Configuration Management Specialist

    2 weeks ago

    Saginaw, Michigan, United States Merrill Technologies Group Full time

    Title Configuration Management Specialist Description Overview: As a configuration management Specialist with MERRILL, you will work in our APEX group processing Engineering changes within ERP and PLM systems. You will collaborate with Estimating team to capture costs, Supply Chain to update supplier purchase orders, Program management, Quality program...

  • Configuration Management Specialist

    4 weeks ago

    Saginaw, United States Merrill Technologies Group Full time

    Title Configuration Management Specialist Description Overview: As a configuration management Specialist with MERRILL, you will work in our APEX group processing Engineering changes within ERP and PLM systems. You will collaborate with Estimating team to capture costs, Supply Chain to update supplier purchase orders, Program management, Quality program...

  • Physician Integration Specialist

    4 weeks ago

    Saginaw, United States Covenant Healthcare Full time

    Covenant HealthCare US:MI:SAGINAW 8:00 AM - 4:30 PM, MONDAY - FRIDAY FULL TIME BENEFITED - 80 HOURS PER PAY Summary: The Physician Integration Specialist - Primary Care will report to CHP Finance Manager and PHO Director of Covenant HealthCare Partners (CHP) and will work as a key member of the CHP team to ensure business practices and policies are...

  • Supply Specialist

    3 weeks ago

    Saginaw, United States Covenant Healthcare Full time

    Covenant HealthCare US:MI:SAGINAW VARIABLE SHIFT FULL TIME BENEFITED Summary: The Operating Room (OR) Supply Specialist functions at a high level to maintain the complexity of their department/environment to ensure a smooth operating flow. The OR Supply Specialist demonstrates excellent customer service performance in their attitude and actions are at...

  • Detention Youth Care Specialist I On-Call

    4 weeks ago

    Saginaw, United States Saginaw County Full time

    Position: Detention Youth Care Specialist Department: Saginaw County Juvenile Detention Center Status: On-Call Classification/Salary: $15.00 / hour GENERAL STATEMENT OF DUTIES Individual in this position is responsible for the direct supervision, guidance, treatment, and care of detained residents with emphasis upon observation, inter-personal relationship,...

  • 42A Human Resources Specialist

    3 weeks ago

    Saginaw, United States Army National Guard Full time

    Job DescriptionWhen a Soldier has a question about benefits, policy, or needs help with a sensitive issue, the Army National Guard's Human Resources Specialist is the primary go-to person. As an HR Specialist, you will help Soldiers develop their Guard careers and provide personnel support and assistance to all divisions within the Guard.Specific...

  • Emergency Department Nurse Manager

    4 weeks ago

    Saginaw, United States Clinical Management Consultants Full time

    This highly recognized and respected hospital in the Mideast region of Michigan is actively searching for an Emergency Department Nurse Manager to provide leadership and oversight of the daily operations of the Emergency Department. This leader will Nurse Manager, Manager, Emergency, Nurse, Department, Patient Care, Healthcare, Staffing

  • Lead Clin Doc Specialist

    4 weeks ago

    Saginaw, United States Covenant Healthcare Full time

    Covenant HealthCare US:MI:SAGINAW DAY SHIFT FULL TIME BENEFITED Summary: The Lead Clinical Documentation Specialist demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary...

  • Dietitian, Specialist

    2 weeks ago

    Saginaw, United States TouchPoint Full time

    TouchPoint **Position Title: DIETITIAN, SPECIALIST - HRLY** **Pay Grade: 1** **Reports To**: CNM **TouchPoint, Support Services,** provides customer focused support services. As specialists, we perform services including healthcare housekeeping, management in laundry processing, patient transportation, and food service. TouchPoint is a compilation of the...

  • Licensing Specialist

    2 weeks ago

    Saginaw, United States Ennis Center Full time

    EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. Category Licensing Specialist / Respite Coordinator DescriptionPosition...

  • Senior Tax Specialist

    4 weeks ago

    Saginaw, United States Hantz Group Full time

    Job DescriptionJob Description Hantz Group Senior Tax Planning SpecialistHantz Group is a Michigan-based financial company that works with individuals and businesses to help them achieve their financial goals. We are a Family Office that manages over $11B+ of assets, has 20+ offices and over 600 employees. We offer a multitude of services tailored to each...

  • Senior Tax Specialist

    2 weeks ago

    Saginaw, United States Hantz Group Full time

    Job DescriptionJob Description Hantz Group Senior Tax Planning SpecialistHantz Group is a Michigan-based financial company that works with individuals and businesses to help them achieve their financial goals. We are a Family Office that manages over $11B+ of assets, has 20+ offices and over 600 employees. We offer a multitude of services tailored to each...

  • Senior Tax Specialist

    4 weeks ago

    Saginaw, United States Hantz Group Full time

    Job DescriptionJob Description Hantz Group Senior Tax Planning SpecialistHantz Group is a Michigan-based financial company that works with individuals and businesses to help them achieve their financial goals. We are a Family Office that manages over $11B+ of assets, has 20+ offices and over 600 employees. We offer a multitude of services tailored to each...

  • Medication Prior Authorization Specialist

    4 weeks ago

    Saginaw, United States CMU Medical Education Partners Full time

    GENERAL STATEMENT OF DUTIES: We are seeking a highly organized and detail-oriented Medical Prior Authorization Specialist to join our outpatient clinic team. The ideal candidate will have a strong background in healthcare administration, particularly in handling prior authorizations for medical procedures, tests, and treatments. This role requires efficient...

  • Tax Planning Specialist

    4 weeks ago

    Saginaw, United States Hantz Group Full time

    Job DescriptionJob Description Tax Planning SpecialistHantz Group is a Michigan-based financial company that works with individuals and businesses to help them achieve their financial goals. We are a Family Office that manages over $11B+ of assets, has 20+ offices and over 600 employees. We offer a multitude of services tailored to each individual client....

  • Tax Planning Specialist

    4 weeks ago

    Saginaw, United States Hantz Group Full time

    Job DescriptionJob Description Tax Planning SpecialistHantz Group is a Michigan-based financial company that works with individuals and businesses to help them achieve their financial goals. We are a Family Office that manages over $11B+ of assets, has 20+ offices and over 600 employees. We offer a multitude of services tailored to each individual client....

  • Tax Planning Specialist

    2 weeks ago

    Saginaw, United States Hantz Group Full time

    Job DescriptionJob Description Tax Planning SpecialistHantz Group is a Michigan-based financial company that works with individuals and businesses to help them achieve their financial goals. We are a Family Office that manages over $11B+ of assets, has 20+ offices and over 600 employees. We offer a multitude of services tailored to each individual client....

  • Senior Tax Specialist

    3 days ago

    Saginaw, United States Hantz Group Full time

    Job DescriptionJob DescriptionSenior Tax Planning SpecialistHantz Group is a Michigan-based financial company that works with individuals and businesses to help them achieve their financial goals. We are a Family Office that manages over $11B+ of assets, has 20+ offices and over 600 employees. We offer a multitude of services tailored to each individual...

  • DC Service Specialist

    4 weeks ago

    Saginaw, United States PepsiCo North America Beverages Full time

    DC Service Specialist - Bay City Area Overview The site address for the requisition: 1000 Calabria Ave, Bay City, MI, 48706. Responsibilities The DC Service Specialist is responsible for ensuring proper system set-up and that run right processes are in place to drive high levels of service performance at the Bay City Distribution Center. The Specialist...